Updated on January 22, 2017 at 11:38 AMPosted on January 22, 2017 at 11:37 AM

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David West listens to speakers arguing for Ohio Medicaid expansion at a meeting on the topic at Mt. Olivet Baptist Church in 2013. West spoke to the audience from personal experience of the need for Medicaid expansion at a meeting of the Greater Cleveland Congregations. Guest columnist John Corlett contends that Medicaid expansion could be in jeopardy if Congress eliminates the Affordable Care Act.
(Thomas Ondrey/The Plain Dealer/file photo)

Nearly a million fewer Ohioans would have health insurance if the Affordable Care Act (ACA) is repealed without a replacement, according to Urban Institute estimates. That's why we appreciate that Senator Rob Portman has encouraged his Senate colleagues to be careful about moving too quickly to repeal the health reform law without a replacement plan clearly defined.

When people with health problems that are treatable don't get the care they need when they need it, they get sicker. They end up in the hospital. They miss work. Many end up with unmanageable medical debt. It's a downward spiral that can doom people to sickness or death and their families to financial ruin.

Since passage of the ACA, individuals living with pre-existing conditions like cancer, heart disease or diabetes, have gained peace of mind knowing they can't be denied coverage or dropped from their plan when they need care most.

Today, families don't have to worry that one accident or illness will lead to bankruptcy, or that if they change jobs, they'll lose health insurance. Young adults can stay on their parents' plan until age 26, which helps them get on their feet financially as they embark on their career. And women are no longer charged more than men for routine coverage and treatment.

Repeal of the ACA would also undo Ohio's successful Medicaid expansion, which provides coverage to over 700,000 Ohioans, including nearly 100,000 Cuyahoga County residents. The Ohio Department of Medicaid just released a comprehensive report that found that those covered reported better health, and improved ability to manage chronic illnesses like high blood pressure, diabetes and mental illness. Their study also found that having health care made it easier to stay employed and, if unemployed, it made it easier to find a job.

Senator Portman helped guide a bill through Congress last year to provide $1.1 billion to states during the next two years to deal with the opiate crisis, but that effort will be undercut if we lose the expanded Medicaid coverage that pays for much of the treatment. He also has made addressing the tragedy of human trafficking a priority; Medicaid coverage benefits the survivors of human trafficking in dealing with addiction/mental health issues that they confront.

ACA repeal also would cost Ohio jobs and economic development. That's because Ohio would lose significant federal funds as marketplace subsidies and the Medicaid expansion end. Even states that didn't expand Medicaid would see declines in federal spending as eligible people fall off the program. In Ohio, repeal means the loss of $3.5 billion in federal Medicaid funding in 2019 and $42.2 billion between 2019 and 2028.

Prior to any repeal vote, we deserve to know what replacement looks like, and as Congress considers a replacement, it should keep in mind the Hippocratic Oath that medical students take, "First, do no harm." That means making sure that nearly a million Ohioans don't lose their health care coverage.

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